一位食道靜脈曲張出血與肝昏迷患者之護理經驗

Caring for a Patient with Bleeding Esophageal Varices and Hepatic Coma

劉舒涵(She-Han Lin)

《馬偕護理雜誌》 5卷1期 (2011/01) Pp. 82-90

https://doi.org/10.29415/JMKN.201101_5(1).0009

摘要

本文係探討一位食道靜脈曲張出血及肝昏迷患者之護理經驗，照顧期間於2008年4月2日至4月8日，運用觀察、會談、收集病史及羅氏適應理論來評估，並確立護理問題有潛在危險性損傷、潛在危險性跌倒、知識缺失之護理問題。針對個案害怕再次出血及因為行動不方便未能按時服用藥物，筆者在護理過程中運用適當的護理措施，例如症狀護理、疾病相關衛教、主動適時陪伴和給予心理支持等措施，並運用食道靜脈曲張出血與肝昏迷之學理為依據及配合醫囑的給藥和治療，以解決身體不適之症狀，降低個案對疾病的焦慮感及讓個案瞭解按時服用藥物的重要性。期望藉此護理經驗提醒同仁，除了解決個案緊急的生理問題外，對於反覆就診之個案，更須深入的評估其潛在問題與需求，並協助處理，以達到整體性、持續性之護理。

關鍵字

食道靜脈曲張出血 ； 肝昏迷

並列摘要

The author cared for a patient with bleeding esophageal varices and hepatic encephalopathy for six days. Assessment was based on observation, interview, a review of the patient's history, and the Roy adaptation model. Health problems identified were anxiety; risks of injury, falling, and rebleeding; and difficulty complying with required immobility. Nursing care measures included symptom-oriented nursing care, education about the disease, active presence, and mental support. Based on an understanding the underlying medical condition as well as the physician's treatment plan, the author worked to reduce the patient's anxiety and improve his understanding of the importance of taking medication on schedule. This case demonstrates the importance not only of managing urgent physical problems but also of anticipating potential problems and needs and helping to deal with them as they arise, in order to achieve integrated continuity of nursing care.

並列關鍵字

esophageal varices hemorrhage ； hepatic enephalopathy